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Full text of "United States Navy Medical News Letter Vol. 44 No. 3, 7 August 1964"

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AUG 1 7 1964 



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UNITED STATES NAVY J.V;. V 

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Vol. 44 



Friday, 7 August 1964 



No. 3 



TABLE OF CONTENTS 



SUBMARINE MEDICINE 

Naval Submarine Medical Center 
Commissioned at New 
London 

Submarine Medical Program. . . . 



MEDICAL ABSTRACTS 

Metabolic Pathways of 

Bilirubin 

Renal Hypertension . . . . 



FROM THE NOTE BOOK (Cont'd) 

Dual Honor Bestowed Upon 

Captain Bruce Canaga 20 

3 New Cobalt 60 Unit for 

6 Oak Knoll 21 

Armed Forces Tri-Service 

Orthopedic Seminar 21 

DENTAL SECTION 



MISCELLANY 

Aerospace Medical Courses. . . . 
NLM Bibliographies Available. . 
13th Annual Armed Forces 

Seminar on OB -GYN 

Retirement of Rear Admiral 

Chrisman, Deputy Surgeon 

General • 

Rear Admiral Brown Becomes 

Assistant Chief of BUMED . . 
Procurement of NavMedP-5040 . 

FROM THE NOTE BOOK 

Captain Phillips Receives 

Distinguished Service Medal. 
American Board Certifications. . 



.8 
10 



14 

15 

15 



Misunderstanding of SnF£ 

Policy -Explanation. 22 

Intraoral Roentgenography . .23 

Professional Notes 25 

PREVENTIVE MEDICINE 

Malaria 27 

Salmonella heidelberg Alert 29 

Smallpox 29 

Hepatotoxic Plants 30 

Chim panzee - As sociated 

Hepatitis - 1963 33 

Meningitis in Newfoundland 34 

Know Your World .35 

NEW SECTION 



,19 U. S. Naval Hospital -Yokosuka 

.20 (First in a Series) 37 

MADIGAN GENERAL HOSPITAL 

MEDICAL LIBRARY 
PROPERTY OF U. S. ARMY 



16 

17 

18 



United States Navy 
MEDICAL, NEWS LETTER 



Vol. 44 Friday, 7 August 1964 No, 3 

Rear Admiral Edward C. Kenney MC USN 
Surgeon General 

Eear Admiral R.B. Brown MC USN 
Deputy Surgeon General 

Captain M. W. Arnold MC USN (Ret), Editor 
Contributing Editors 



Aviation Medicine Captain C. E. Wilbur MC USN 

Dental Section Captain C. A. Ostrom DC USN 

Occupational Medicine jCDR N. E. Rosenwinkel MC USN 

Preventive Medicine Captain J. W. Millar MC USN 

Radiation Medicine .CDR J. H. Schulte MC USN 

Reserve Section .Captain K. W. Schenck MC USNR 

Submarine Medicine .CDR J. H. Schulte MC USN 



Policy 

The U.S. Navy Medical News Letter is basically an official Medical Depart- 
ment publication inviting the attention of officers of the Medical Department 
of the Regular Navy and Naval Reserve to timely up-to-date items of official 
and professional interest relative to medicine, dentistry, and allied sciences. 
The amount of information used is only that necessary to inform adequately 
officers of the Medical Department of the existence and source of such infor- 
mation. The items used are neither intended to be, nor are they, susceptible 
to use by any officer as a substitute for any item or article in its original 
form. All readers of the News Letter are urged to obtain the original of those 
items of particular interest to the individual. 

Change of Address 

Please forward changes of address for the News Letter to: Commanding Offi- 
cer, U. S. Naval Medical School, National NaVal Medical Center, Bethesda, 
Maryland 20014, giving full name, rank, corps, and old and new addresses. 



The issuance of this publication approved by the Secretary of the Navy on 
4 May 1964. 



U.S. Navy Medical News Letter, Vol. 44, No. 3 

SUBMARINE MEDICINE SECTION 




Naval Submarine Medical Center 
Commissioned at New London 



Introduction 

July 1, 1964 marked a significant milestone in the history of submarine medi- 
cine. On that date, the Naval Submarine Medical Center was commissioned at 
the U. S. Naval Submarine Base New London, Groton, Connecticut, by order 
of the Honorable Paul H. Nitze, Secretary of the Navy. The commissioning 
ceremony was attended by RADM V. L. Lowrance USN, Deputy Commander 
Submarine Force Atlantic Fleet; RADM W. Welham MC USN, Assistant Chief 
of the Bureau of Medicine and Surgery; CAPT N. D. Gage USN, Commanding 
Officer, U. S. Naval Submarine Base New London; CAPT G. J. Duffner MC USN, 
Fleet Medical Officer, Atlantic Fleet;CAPT C. N. Waite MC USN, Commanding 
Officer, Naval Submarine Medical Center; and many other dignitaries and 
guests. RADM E. C. Kenney MC USN, the Surgeon General, was the principal 
speaker. 

Commissioning Address 
by 
Rear Admiral Edward C. Kenney MC USN 
Surgeon General 

It is a great pleasure to participate in this most significant occasion. This 
day marks the realization of many hopes, and is the fruition of much labor and 
overall coordination. With the full cooperation and support of the Commander 
of the Submarine Force, Atlantic Fleet, the many problems inherent in the 
establishment of this Medical Center were overcome and today, we are gathered 
to dedicate it to the betterment of submarine medicine and to the people whom 
it will serve. 

Although we have had medical officers trained in submarine medicine 
since 1931, it wasn't until 1943, just 21 years ago, that submarine medicine 
was established as a military specialty. At that time, a special submarine 
medical insignia was approved for submarine medical officers and the qualifi- 
cations were established for eligibility to wear the insignia. Submarine medi- 
cine is considered to have "come of age" in 1947 with the formal establishment 



4 U. S. Navy Medical News Letter, Vol. 44, No. 3 

of a Submarine Medicine Division in the Bureau of Medicine and Surgery, and 
the implementation of a formal training program. At that time, the submarine 
medical organization consisted of approximately five senior medical officers 
who rotated in the five senior billets. The remainder of the organization was 
composed of six to ten junior officers who ofttimes, upon completion of the 
training, either left the program or left the Navy. 

The original training program consisted of twelve weeks indoctrination 
at the Naval School, Deep Sea Divers, in Washington-followed by six months 
at the Submarine School and Research Laboratory in New London. Prospec- 
tive submarine medical officers attended the same school as the prospective 
line officers and actually spent approximately two-thirds of their time in 
training with them. While they were provided with a great deal of practical 
information concerning submarine operations, it could be described as "fringe" 
insofar as a medical officer's educational needs are concerned. 

Since World War II, personnel especially trained in submarines have 
provided the medical support for all underwater operations in the Navy. With- 
in the past ten years, however, there have been major developments which 
have emphasized the need for, and greatly increased the demands for medical 
officers trained in submarine medicine with their professional skills and ad- 
vanced training in the fields of respiratory physiology, radiological health, 
and atmospheric hygiene. 

The submarine service has become a highly intricate and complex or- 
ganization, with current problems unknown in former years. The increased 
requirements for specially trained personnel are not limited to medical offi- 
cers, but include Medical Service Corps officers and hospital corpsmen-and 
certainly, not among the least, scientists to pursue a research program with 
basic and applied projects closely integrated with the submarine medical 
programs. 

The American Board of Preventive Medicine currently credits sub- 
marine, diving, and radiation medicine training as full-time formal training 
toward the eligibility requirements for certification in occupational medicine. 
The establishment of this Submarine Medical Center will provide billets in the 
future for "In-Plant Training" in this specialty, as required by the American 
Board. With the increasing number of submarine medical officers in off-cruise 
status in the area, there is a critical need and desirability for these officers 
to have the opportunity to practice clinical medicine. This can be provided at 
the Center. I am also confident that the prospect of future duty at the Center, 
where clinical, research, and teaching pursuits will be available, will be an 
attractive incentive for physicians to enter, and remain associated with, this 
field of Navy medicine. 

The teaching programs will benefit immeasurably through coordination 
and integration with clinical and research facilities which will be effected by 
the Center arrangement, The cohesion of the staffs of the laboratory, the 
school, and the station hospital will broaden their scope of service and more 
effectively capitalize on the talents and experience of these highly trained per- 
sonnel. The unified command is expected to bring about operating economies, 



U.S. Navy Medical News Letter, Vol. 44, No. 3 5 

better utilization of skilled medical personnel by creating a "pool" of these 
persons available for all the functions of the Center, and to make possible 
more effective administration. 

Another facet, which should hit closer to home, is the dependent health 
care. If the men of the fleet are to operate efficiently, their health, as well 
as that of their dependents, must be zealously guarded. With five Squadrons 
homeported in New London and the additional medical officers available in the 
POLARIS Program, there is every reason to believe that the medical needs 
of our personnel and their dependents will be provided for more effectively 
under our concept of the Submarine Medical Center. 

This is one more significant step in the maturity of submarine medi- 
cine. There has been much groundwork preceding this event. Sedulous effort 
on the part of so many who have made this event possible should be duly ac- 
knowledged. Today's activities are the result of many months of viewing, 
reviewing, analyzing, criticizing, study groups, liaison groups, official 
conferences, and unofficial pros and cons, by personnel of the Office of the 
Inspector General, the Commandant, THIRD Naval District, the Submarine 
Base; the Research Laboratory; the Station Hospital; the Submarine School; 
the Deep Sea Divers School; BUPERS; BUSHIPS; - numerous activities within 
BUMED; - and others - too many to recall and mention by name. 

I would like to express my sincerest appreciation for the contributions 
made by all who have participated in this project. The means to this end were 
quite obviously the result of a thorough staff study, conscientiously conducted 
with concerted effort to contrive the best possible solution. We know that there 
will be changes to the present organization of this Center, —all with a view to 
improvement in its operation. However, we are today establishing the nucleus 
for a "Home Base" for submarine medical personnel with training for sub- 
marine duty as one of its primary missions. It will also provide improved 
courses of instruction and facilitate expansion in case of emergency. The as- 
signment of qualified submarine medical officers, who may also be qualified 
in a clinical specialty , to a medical facility that supports submarine personnel 
should be beneficial to the morale of the officers and enlisted men and their 
dependents. 

We can look forward to more recognition and publicity in this field of 
operational medicine with the Submarine Medical Center establishment, there- 
by increasing the number of medical officers, hospital corpsmen, and others 
who volunteer for the submarine program. An increase in reenlistments and 
a greater retention of medical officers in the program can then be anticipated. 
While reducing overall costs, the Center will provide better service to the 
men in the submarine force and to their dependents, will be professionally 
satisfying to the medical officers; and should be a contributing factor in the 
advancement of the Navy's undersea capability. 

A >fc rfc >k **£ >k 



6 U.S. Navy Medical News Letter, Vol. 44, No. 3 

Submarine Medicine Program 

Submarine medicine is the military medical specialty which supports all under- 
water operations in the Navy. This includes medical services to the crews of 
all types of submarines as well as medical care of deep sea divers and under- 
water swimmers. The practice of submarine medicine can be considered a 
combination of general practice and of occupational medicine. 

The training course in Submarine Medicine is conducted at the Sub- 
marine Medical Center, Naval Submarine Base New London, Groton, Connecti- 
cut. The six months course convenes twice yearly — in August and February. 
The cirriculum includes Underwater Pressure, and Respiratory Physiology; 
Radiobiology; Environmental Health, Toxicology; and familiarization and 
orientation with submarine and diving operations. 

Upon completion of this training course, medical officers are assigned 
to billets within the submarine force. In most instances, it is possible to give 
favorable consideration to the desires of each graduate. Although the sub- 
marine medicine organization is a small one, the program is experiencing a 
rapid growth at this time. The table on page 7 reflects the current submarine 
billets for medical officers. 

The Navy's highest priority operation is the Fleet Ballistic Missile or 
POLARIS Submarine Program. Each of these submarines has two complete 
crews. While one crew is on patrol in the submarine, the other crew remains 
ashore. A medical officer is assigned to each crew because of the nature of 
the patrols. 

A certain number of medical officers may anticipate serving as Squad- 
ron medical officers. In this capacity, the medical officer has overall respon- 
sibility for the medical care of approximately 2000 officers and men. 
Submarine Squadrons are located at New London, Connecticut; Norfolk, Vir- 
ginia; Charleston, South Carolina; Key West, Florida; San Diego, California; 
Pearl Harbor, Hawaii; Rota, Spain; and Holy Loch, Scotland. 

Medical officers are also assigned to the Naval School, Deep Sea Divers 
and the Navy Experimental Diving Unit, Washington, D. C. , to teach the medi- 
cal aspects of diving and conduct research in underwater physiology. Sub- 
marine Medical Officers also serve with Underwater Demolition Teams. 

For those who have gained experience in the operational field, billets 
are available at the Submarine Medical Center. The Center consists of a re- 
search laboratory, a hospital, and a school. Research investigators in all as- 
pects of submarine medicine are needed at the laboratory; clinicians in all 
major specialties are needed at the hospital;and teachers for the medical of- 
ficers and hospital corpsmen courses are required at the school. Experienced 
Submarine Medical Officers are urged to apply for further post-graduate or 
residency training. 

Submarine Medicine offers excellent opportunities in all areas of med- 
icine. Through its various possibilities, it provides additional training not 
otherwise available and permits doctors to better perform their military duties 
and enhance their professional futures. 



U. S. Navy Medical News Letter, Vol. 44, No. 3 



Submarine Billets for Medical Officers* 



Lt. 



LCdr. Cdr. Capt. Total 



Forces Afloat 
Polaris 

New Construction 
Submarine Tenders 
Underwater Demolition, SEAL, 
Torpedo Stations 
Submarine Squadrons 
Submarine Flotillas 
Submarine Forces 
SuBase Dispensary (Hawaii) 

Submarine Medical Center 
Submarine School 
Station Hospital 
Research Laboratory 



82 

5 

10 

3 



2 
14 



82 
5 

10 
3 
2 

14 
5 
2 
4 

2 

7 

12 

5 



E. D. U. & N. S. D. S. D. 

{Experimental Diving Unit 
and Divers' School) 



NMRI 



(Naval Medical Research 
Institute) 



AFRRI 



(Armed Forces Radiobiology 
Research Institute) 



BUREAUS 



TOTALS 



* Billets available, but not 

necessarily filled at all times. 







2 


4 


6 


100 


37 


20 


10 


167 


Lt. 


LCdr. 


Cdr. 


Capt. 


Total 



Anyone desiring further information regarding the Submarine Medicine Pro- 
gram should address inquiries to CDR John H. Schulte MC USN, Director, 
Submarine Medicine Division, Bureau of Medicine and Surgery, Washington, 
D. C. 20390. 



U. S. Navy Medical News Letter, Vol. 44, No. 3 

Metabolic Pathways of Bilirubin 

LT Joseph T. Brierre Jr. MC USN*, U. S. Navy Medical Laboratory 
Quarterly 2(1): 2-5, January 1964. 



Understanding current concepts of bilirubin formation and excretion isimpor- 
tant in properly interpreting certain abnormal states of the reticuloendothelial 
system, liver, extrahepatic bile-carrying channels and the alimentary canal. 

Degradation and destruction of erythrocytes result in the formation of 
hemoglobinated fragments and, finally, of free bilirubin. Free bilirubin is 
conjugated with glucuronic acid in the liver and excreted in this form of the 
water soluble glueuronide. Figure No. 1 presents current basic concept as to 
the site of formation of the various hemoglobin breakdown products which form 
bilirubin and its biochemical successors. 



HEMOGLOBIN 



BLOOD 



R. E. CELL 



BLOOD 

PARENCHYMAL 
CELL (LIVER) 

BILE DUCTS 
G. 1. TRACT 

STOOL 



1 



Verdohemoglobin 

t 

Bilirubin 



-^-Fe to Fe plasma pool 
_^- Globin to protein pool 



Indirect bilirubin 
(unconjugated, fat soluble) 

------J- ---/' 

/ ^ / 

. Glucuronyl transferase 

y- +-' 

Bilirubin mono- and di-glucuronide 
(conjugated, water soluble) 



i 



Mesobilirublnogen 

t 

Urobilirubinogen ^ 
Stercobilirubinogen 



1 

I 
I 

I 

I 
I 



Urobilin 
Stereo bilin 



X 



Urobilin 
Stercobilin 



URINE 



Figure I. 



Hepatic conjugation of bilirubin with glucuronic acid is limited by: 

1. The amount of available glucuronic acid donor: uridine diphosphoglucu- 
ronic acid and, 

2. The availability of the conjugating enzyme, glucuronyl transferase. Nor- 
mally, conjugated bilirubin present in blood represents the diglucuronide 
form. 



* Fourth Year Resident in Pathology, TJ. S. Naval Medical School, NNMC, 
Bethesda, Md. 



U.S. Navy Medical News Letter, Vol. 44, Nc. 3 



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10 U.S. Navy Medical News Letter, Vol. 44, No. 3 

Other relatively regular physiologic constants influencing bilirubin formation 
are (calculated for a 70 kilogram male): 

1. Average erythrocyte life span - 120 days. 

2. Therefore, the daily average of red blood cells destroyed is: 

100% - 0. 83%/day 

120 days 

3. One gram of hemoglobin yields 35 mgm of bilirubin. 

4. A 70 kilogram body normally contains 750 grams of circulating hemo- 
globin and degrades 6. 25 grams/day. 

5. This hemoglobin produces 220 mgm of bilirubin/day. 

6. Unconjugated bilirubin circulates approximately 1-1 1/2 hours before 
it is wholly removed from the circulation. 

Figure No. 2 (see page 9) presents, in tabular form, some of the more com- 
monly performed laboratory tests of liver function with the normal values, 
some precautions to be observed in their use and a key to interpretation. 

*J> «lV JU *X» *,'r* <*!s 

* f f f *F f- 

Renal Hypertension 

B.G.Clarke MD*, Associate Professor of Urology, Tufts University School 
of Medicine and J. Hartwell Harrison MD**, Clinical Professor of Genito- 
urinary Surgery, Harvard Medical School. Reprinted by permission of the 
authors from "Diseases of the Urinary and Genital Organs" (A Review and 
Bibliography) - pps 125-130, Boston, Mass., I960.*** 

There are two principal endocrine pathways for the development of hypertension 
in the mammalian organism. One is primarily neurogenic, mediated through 
the hypothalamic -pituitary -adrenal axis and the other is renal. 

The role of the hypophysis in production of hypertension is still contro- 
versial. Hypothalamic chemo-receptors, the pituitary antidiuretic hormone, 
and pituitary corticotrophins may affect the elaboration of the adrenal salt- 
retaining hormone aldosterone and of other adrenal steroids. These may in- 
fluence the generalized vasoconstriction leading to hypertension. 

The relationship between the kidneys and hypertension has been recog- 
nized for some time. As early as 1898 it was found that an extract of animal 
kidneys (renin) is capable of inducing a pressor effect when injected intrave- 
nously into animals. More recently, it has been shown that renin is not directly 
pressor but its effect is the result of reaction with a substrate in the plasma 
which has been known as hypertensin or angiotonin. This has more recently 
been re-designated angiotensin, identified as a tetradecapeptide, and synthe- 
sized. An enzyme normally present in the kidney, hypertensinase, regulates 
the inactivation of angiotensin according to the homeostatic requirements of 
the body. 

Efforts to induce hypertension experimentally were consummated by 
Goldblatt's work between 1928 and 1934. He showed that carefully controlled 



U.S. Navy Medical News Letter, Vol. 44, No. 3 11 

constriction of one or both renal arteries was capable of inducing chronic 
hypertension in dogs and, after a lapse of time, arteriolar sclerotic lesions 
similar to those found in the human disease. Hypertension appears to be a 
necessary condition for development of arteriolar sclerosis, which is almost 
always found in persons with essential hypertension. Selye partly occluded 
the aorta in rats, above one kidney and below the other, and found vascular 
lesions confined to areas above the constriction where hypertension existed, 
but not below it in the normotensive parts of the body. 

Goldblatt's phenomenon is probably explained by the fact that renin is 
produced continuously in small quantities by the normal kidney but its pro- 
duction is increased under many conditions of renal ischemia. It has been 
shown that excessive production of renin occurs when renal arterial pressure 
is reduced enough to decrease or arrest glomerular filtration but not reduced 
to the point where tubular cells are no longer viable. Renal parenchyma will 
remain viable at pressures below those required for filtration. Probably tu- 
bular cells, under these conditions, liberate excessive quantities of renin, to 
produce hypertension. 

Important evidence of the renal origin of hypertension is that it cannot 
exist without some functioning renal tissue. A patient whose only kidney was 
inadvertently removed was kept alive for 57 days by external dialysis, but 
hypertension did not develop in spite of marked rise in serum epinephrine and 
norepinephrine. 



1. The Renal Origin of Hypertension, Goldblatt, H. : Springfield, 111. , Charles 
C. Thomas, Publisher, 1948, pp 126, 

2. Experimental Renal Hypertension. Page, I. H. ; and Corcoran, A. C. rSpring- 
field, 111. , Charles C. Thomas, Publisher, 1948, pp 72. 

3. The Current Status of the Hypertension Problem. Kahn, J. R. : Am J Clin 
Path 76: 521-523, May 1956. 

4. The Synthesis of a Tetradecapeptide Renin Substance. Skeggs, L. T. ;L.entz, 
K. G. ; Kahn, J. R. ;and Shumway, N. P. : J Exp Med 108:283-297, September 
1, 1958. 



Clinical considerations, In human beings, hypertension is known to result 
from primary lesions of the renal vessels, from the nephritides, from con- 
genital renal anomalies, and from acquired obstructive uropathies. These 
factors may be outlined as follows: 

I. Primary vascular lesions(major vessel or branches, unilateral or bilateral) 

A. Embolus with infarction 

B. Renal vascular thrombosis 

1. Spontaneous 4. Renal arterial stenosis 

2. Traumatic 5. Intimal proliferation and fibrosis of 

3. Aneurysm renal vessels or aorta at renal ar- 

terial orifices 



12 U. S. Navy Medical News Letter, Vol. 44, No. 3 

I. Primary vascular lesion 

C. Extrinsic compression of renal artery by tumor 

II. Nephritides 

A. Pyelonephritis B. Glomerulonephritis 

III. Congenital anomalies 

A. Polycystic disease D. Stenosis of vesical neck 

B. Hydronephrosis E. Hypoplasia of the 

C. Megaloureter kidneys 

IV. Acquired obstructive uropathy 

A. Prostatic hyperplasia D. Extrensic ureteral 

B. Nephrolithiasis obstruction due to 

C. Urethral stricture tumor 

It has become apparent that if the cause of renal hypertension can be removed 
early enough in the course of the disease, arteriolar sclerosis resulting from 
hypertension (as observable in the eyegrounds and reflected in renal function) 
can be largely or completely reversible. If one kidney is ischemic and causing 
hypertension the other need not be absolutely normal for recovery to follow 
removal of the ischemic organ. Leukocytosis, polyuria, albuminuria, and 
impairment of urinary concentrating ability may allbe a part of the reversible 
form of the syndrome: Surgery has three potential roles in the treatment of 
renal hypertension; (1) The correction of obstructive uropathies according to 
usual indications ;{2) The resection of ischemic renal tissue provided that only 
one kidney, or part of a kidney is involved in vascular obstruction, infarction, 
nephritis, or anomaly; or (3) The surgical reconstruction or replacement, of 
an obstructed renal vessel or vessels. Under these conditions, provided that 
arteriolar sclerosis in the remaining renal cortex has not advanced to an ir- 
reversible degree, sustained remission of hypertension may be anticipated in 
the majority of cases. 

In the selection of patients for surgical treatment a number of technics 
are undergoing evaluation. Winter has introduced measurement of renal radio- 
activity after intravenous injection of radioactive diodrast as a screening test. 
Differential measurement of parameters of renal functionby way of cystoscopi- 
cally introduced ureteral catheters, has been studied by Howard and others. 
Urine volume, glomerular filtration rate, sodium excretion, osmolality, urea 
clearance and other tests are useful in this regard but are not absolute diag- 
nostic criteria. Bilateral constriction of the major renal arteries or segmental 
infarction of one kidney, for example, will not necessarily be reflected in a 
difference in function between the two kidneys yet hypertension may be curable 
by repair of the vessels or by partial nephrectomy. 

Renal angiography (aortography) provides a more accurate definition 
of surgically remediable ischemic lesions of the kidneys. It is indicated, ac- 
cording to Poutasse and Dustan, in hypertensive patients under the following 
conditions: (1) When pyelograms show disparity between the two kidneys in 
size, structure, or function, (2) In patients with nonfamilial hypertension of 



U.S. Navy Medical News Letter, Vol. 44, No. 3 13 

recent onset with rapid progression into the malignant phase, (3) When hyper- 
tension with no other evident cause develops in a patient less than 35 years of 
age; and (4) When hypertension develops or becomes worse following an at- 
tack of flank pain which might represent infarction of part of the kidney. 

When a vascular lesion is thus disclosed, treatment may consist, 
depending upon circumstances, of endarterectomy, renal arterial or aortic 
reconstruction or grafting, spleno-renal arterial anastomosis, or segmental 
or total nephrectomy. About two thirds of patients undergoing such treatment 
may anticipate cure. 



* Doctor Clarke's current address is 1224 Jefferson Bldg. , Peoria, Illinois 
61602. He holds the rank of Commander in the Medical Corps of the Ready 
Reserve, and is engaged in the private practice of Urology. He served as 
a medical officer on active duty with the Navy during World War II and the 
Korean Conflict. We are indebted to both authors for this opportunity to re- 
publish their material. 
** Doctor Harrison holds the rank of Lt. Col. MC AUS, Retired. 
*## Doctors Clarke and Harrison had a thousand copies of this publication made 
and distributed to students and house officers at Harvard and Tufts. The 
supply is now exhausted. Through special permission of the authors, it is 
planned to republish in future issues of the Medical News Letter, selected 
papers from this excellent 137 -page document. 

— Editor 



Suggested Reading List: 

Surgical Management of Hypertension due to Renal Artery Occlusion. Trippel, 
O. H. : Surg Clin of N. Amer 40: 177-189, February I960. 

Hypertension Due to Unilateral Renal Disease: With Report on Functional Test 
Helpful in Diagnosis. Connor, T. B. ;Berthrong, M. ;Thomas, W. C. ; and 
Howard, J. E. : Bull Johns Hopkins Hosp 100: 241-276, July 1957. 

Results of the Radioisotope Renogram and Comparison with Other Kidney 

Tests among Hypertensive Persons. Winter, C. C. ;Maxwell, M. H. ;Rockney, 
R. E. ; and Kleeman, C. R. : J Urol 82: 674-680, December 1959. 

Diagnosis of Hypertension Due to Occlusions of the Renal Artery, Margolin, 
E. G. ;Merrill, J. P. ; and Harrison, J. H. : New England J Med 256: 581-588 
March 28, 1957. 

Occlusion of a Renal Artery as a Cause of Hypertension. Poutasse, E. F. : 
Circulation 13: 37-48, January 1956. 

Arteriosclerosis and Hypertension. Indications for Aortography in Hyperten- 
sive Patients and Results of Surgical Treatment of Obstructive Lesions of 
Renal Artery. Poutasse, E. F. ; and Dustan, H. P. : JAMA 165: 1521-1525, 
November 23, 1957. 

(The reading list will be continued in the next issue of the News Letter) 

9je ^ 3(: s}; jjt $ 



14 



U.S. Navy Medical News' Letter, Vol. 44, No. 3 




MISCELLANY 



Announcement of Aerospace Medical Courses 













Deadline Date 




Course 


Class 




Inclusive 


Dates 


to Apply 


Quota 


Medical Support 


64-C 


30 


Nov - 11 


Dec 1964 


Immediately 


2 


for Missile 


65-A 


8 


Feb - 19 


Feb 1965 


14 Dec 1964 


3 


Operations 


65-B 


1 


Mar - 12 


Mar 1965 


4 Jan 1965 


3 




65-C 


7 


Jun - 18 


Jun 1965 


12 Apr 1965 


2 


Medical Support 














for Space Flight 


65-A 


10 


May - 3 


Jun 1965 


15Mar 1965 


6 



The above scheduled courses will be conducted by the U. S. Air Force Medical 
Service at the School of Aerospace Medicine, Brooks Air Force Base, Texas. 
SECRET Security Clearance is required on all candidates approved for attend- 
ance. 

The presentation of Medical Support for Missile Operations is designed 
to provide selected officers of the Medical Services of the Armed Forces of 
the United States with essential fundamental knowledge for the organization 
and implementation of a medical support program at a missile site. Instruction 
is presented to familiarize the graduate with operational weapons systems and 
with the various toxic substances and hazardous conditions associated with 
missile operations. A field trip is an integral part of this course. 

The purpose of the course, Medical Support for Space Flight is to 
familiarize selected physicians of the Department of the Army, Navy, and Air 
Force with the physical and chemical aspects of the upper atmosphere and 
space and the biomedical impact of these factors on man, and to permit active 
participation in medical support of future man-in-space programs. Prereq- 
uisites include: (1) Must be a Regular or Career Reserve Medical Officer; 
(2) Must have satisfactorily completed the course in Aerospace Medicine, Pri- 
mary, as conducted by the United States Air Force, or the Basic Course for 
Flight Surgeons as conducted by the United States Navy; (3) Must be actively 
engaged in the teaching or practice of Aviation Medicine or conducting aero- 
medical research. A five-day field trip to a missile range is an integral part 
of this course and clothing suitable for flying will be needed. 

Requests should be forwarded in accordance with BUMED INST. 1520. 8A 
of 29 June 1964, and comply with deadline date as indicated above. All requests 



U.S. Navy Medical News Letter, Vol. 44, No. 3 15 

must indicate that a security clearance of SECRET has been granted to the 
officer requesting attendance. —Training Branch, Professional Div. , BuMed. 

$$$$$$ 

NLM Bibliographies Available 

Facsimile copies of typewritten lists of selected references on the following 
subjects are available on request from the Reference Section of the Reference 
Services Division, National Library of Medicine, U. S. Department of Health, 
Education, and Welfare, Bethesda, Maryland 20014. 

1. Appendiceal Lithiasis (85 references) 

2. Chymopapain (1 1 references) 

3. Fatigue Countermeasures (44 references) 

4. Hematomas of the Abdominal Wall Secondary to Coughing 
(21 references) 

5. List of U. S. State Medical Society Journals 

6. Myocardial Pain Syndrome (20 references) 

7. Nutritional Factors in Mental Deficiency (22 references) 

8. Orthopedic Metallic Implants (17 references) 

9. Subcutaneous Toxicity of Aluminum (8 references) 

10. Toxoplasmosis in Mental Illness (29 references) 

11. Ulcers of the Jejunum and Ileum (14 references) 

—From the National Library of Medicine NEWS XIX(6): 3-4, June 1964. 

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Thirteenth Annual Armed Forces Seminar 
on Obstetrics and Gynecology 

The Air Force will act as host for the subject seminar, which will be held at 
the U. S. Air Force Hospital Andrews, Andrews Air Force Base, Maryland, 
26-29 October 1964. 

All surgeons and residents in this specialty, on active duty are eligible 
to attend. Only a limited number of officers can be authorized to attend the 
seminar on travel and per diem orders chargeable against Bureau of Medicine 
and Surgery funds. Eligible and interested officers who cannot be provided 
with travel orders to attend at Navy expense may be issued Authorization 
Orders by their Commanding Officers following confirmation by this Bureau 
that space is available. Requests should be forwarded via chain of command, 
in accordance with BUMED INST. 1520. 8A. NOTE: The deadline date for 
receipt of requests in this Bureau is 20 August 1964. 

— Training Branch, Professional Div. , BuMed. 

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16 



U. S. Nav> Medical News Letter, Vol. 44, No. 3 



Retirement of RADM C hrisman 
Deputy and Assistant Chief of BuMed 

Retirement ceremonies were held on 
30 June 1964, in the Office of the Sur- 
geon General of the Navy, for RADM 
Allan S. Chrisman, Medical Corps, 
U. S. Navy, then Deputy and Assistant 
Chief of the Bureau of Medicine and 
Surgery. 

Attending the ceremony, during 




Rear Admiral A. S. Chrisman 
Official U. S. Navy photograph, Naval 
Medical School, Bethesda, Md. 20014 



which Admiral Chrisman received the 
BUMED Certificate of Merit from the 
Surgeon General, RADM E. C. Kenney, 
were his many friends and fellow of- 
ficers of the Bureau. 

Admiral Chrisman was placed on 
the Retired List of the U. S. Navy after 
more than 34 years of continuous serv- 
ice. He had served as Deputy and As- 
sistant Chief, BUMED, since April 24, 
1961. 

Dr. Chrisman graduated from the University of North Carolina, with a 
Bachelor of Science degree and received the degree of Doctor of Medicine from 
Harvard Medical School in 1930. 

His military career included duty at the Naval Hospitals, Philadelphia, 
San Diego, Washington, D. C. , Parris Island, Bethesda, Bainbridge, Newport, 
Aiea Heights, and Camp Lejeune; duty aboard the USS S-4, USS BEAVER, 
USS RANGER, USS PINKNEY; duty at the Submarine Base, New London, and 
was a student, for the senior course, at the Naval War College, Newport, R.I. 
In the early years of World War II he saw action in the South Pacific Area and 
served as Base Medical Officer at the Advanced Naval Base, Tulagi, Solomon 
Islands, where he was in charge of the Tulagi-Florida Medical Facilities. In 
January 1944, he was Assistant Officer in Charge of the Medical Research Lab- 
oratory, New London. As such he assisted in submarine personnel selection 
for Commander Submarines, Atlantic. He was awarded a Letter of Commenda- 
tion, with Ribbon, from the Commander-in-Chief, U. S. Atlantic Fleet, "For 
meritorious service as Assistant Medical Officer in Charge of the Medical Re- 
search Department, U. S. Submarine Base, New London, Conn. , during the 
period from March 1944 to February 1945. "In September, 1952, he assumed 
duties as Director, Personnel Division, BuMed. On July 31, 1956, he was or- 
dered to San Diego, California, as Commanding Officer of the Naval Hospital 
there, and in December 1958 was assigned additional duty as Eleventh Naval 
District Medical Officer with Headquarters at San Diego. 

He is a member of the American Medical Association, a Diplomate of 
the American Board of Preventive Medicine and a Fellow of the American 



U. S. Navy Medical News Letter, Vol. 44, No. 3 



17 



College of Preventive Medicine. He is also a member of Phi Kappa Sigma, Phi 
Chi, and Phi Beta Kappa fraternities and the Masonic Order. 

He is married to the former Eleanore Krekeler of Montclair, New 
Jersey, and has three children, Caroline, Allan and Jane ( Mrs. Albert 
McBride ). Admiral Chrisman has accepted employment as Deputy Director 
of Medical Services, American National Red Cross, Washington, D. C, He will 
continue to reside at his present address in Bethesda, Maryland. 

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RADM Brown Assumes Duty As 
Deputy and Assistant Chief of BuMed 



On 1 July 1964, Rear Admiral Robert 
B. Brown MC USN, became Deputy 
SurgeonGeneral and Assistant Chief 
of the Bureau of Medicine and Sur- 
gery onordersfrom the Chief of Na- 
val Personnel. He had served since 
1 August 1963 as Assistant Chief of 
BUMED for Personnel and Profes- 
sional Operations. 

Admiral Brown brings to his new 
assignment an illustrious record of 
achievements in behalf of the advance- 
ment of professional and administra- 
tive matters within and outside the 
Medical Department of the Navy. 
Prior to his Bureau service some of 
his important duties were: 

Commanding Officer, National 
Naval Medical Center, Bethesda, Md. 

Commanding Officer, U.S. Naval Hospital, NNMC, Bethesda, Md. 

Chief of Surgical Service, U. S. Naval Hospital, Bethesda, Md. 

Clinical (Adjunct) Professor of Surgery, Georgetown Univ. School of Medi- 
cine. 

Chief of Surgical Service and Chief of Professional Services, USS REPOSE 
(1950-1951)— for which Admiral Brown was awarded the Bronze Star Medal. 
The citation states in part: "For meritorious service as Chief of Professional 
Services and as Chief of Surgical Service in the Naval Hospital on board the 
USS REPOSE, in connection with operations against enemy aggressor forces 
in Korea from September 20, 1950 to July 12, 1951. Throughout this period, 
CAPT Brown rendered outstanding services to his patients and directly super- 
vised the surgical treatment of all casualties admitted to his section. Exer- 
cising exceptional professional skill and a thorough understanding of the scope 
and importance of his assignment, he was largely responsible for the excellent 



Rear Admiral R. B. Brown 
Official U. S. Navy photograph, Naval 
Medical School, Bethesda, Md. 20014 



18 U.S. Navy Medical News Letter, Vol. 44, No. 3 

care given to the more than 8000 patients admitted to the hospital and was 
greatly instrumental in saving the lives of many of the stricken men. " 
Chief of Surgery, USS TRANQUILLITY, 1945 

Chief of Surgery, U.S. Naval Hospital, Annapolis, Md. , 1943 
Duty aboard the USS SOLACE, 1943 

Having obtained the B. S. degree from Allegheny College, Meadville, 
Pennsylvania (1925-1929) and his Doctor of Medicine degree from the Univer- 
sity of Pennsylvania (1929-1933), Doctor Brown received comprehensive grad- 
uate training at the University of Pennsylvania in General Surgery, and one 
year in Thyroid and Neurosurgery. During the period 1935-1941 he also served 
variously as Assistant Instructor in Surgery at the Medical School there, In- 



structor in Surgery, and Assistant in Surgery at the University of Pennsylvania, 
Philadelphia General, Presbyterian and Doctors' Hospitals. In 1941 he re- 
ceived his Doctor of Science (in Surgery) degree from the University of Penn- 
sylvania Graduate School of Medicine. During the period 1933-1935 he interned 
at the Hospital of the University of Pennsylvania. 

In addition to the Bronze Star Medal, Rear Admiral Brown has the fol- 
lowing service medals: Asiatic -Pacific Campaign Medal with one star;Ameri- 
can Campaign Medal; World War II Victory Medal; National Defense Service 
Medal;Korean Service MedaljUnited Nations Service MedaljExpert Rifleman 
Medal and the Expert Pistol Shot Medal. He also has the Korean Presidental 
Unit Citation. 

Dr. Brown is a Fellow of the American College of Surgeons and a Dip- 
lomate of the American Board of Surgery. He is a member of the Philadelphia 
County, the Pennsylvania State and American Medical Associations; the Society 
of University Surgeons; the American Surgical Association; the International 
Surgical Society; the Eastern Surgical Association; the Society of Vascular Sur- 
gery; the Southern Surgical Association; the American Association for the Sur- 
gery of Trauma; and Associate Member, Clinico- Pathological Society, Washing- 
ton, D. C. and Philadelphia Academy of Surgery. In 1962 he received anhonorary 
Doctor of Science degree from Allegheny College, Meadville, Pennsylvania. 

His official home address is 704 Chestnut Street, Meadville, Penna. 
He is married to the former Jane Richardson of Pitman, New Jersey, and has 
a daughter, Mrs. Joan Brown Cox of Indiana. 

'I s '<- T f >p Sp 

Notice Concerning Future Procurement of NAVMED P-5040 - "Code for Use 
of Flammable Anesthetics" (Safe Practice for Hospital Operating Rooms). The 
current supply of subject publication in BuMed is exhausted. In consideration 
of the small (50£) cost involved, and since this is a commercial copyrighted 
document, it is felt that all customers should procure their required needs 
direct from its source— National Fire Protection Association, Internationa], 
60 Batterymarch Street, Boston 10, Massachusetts. When referenced instruction* 
is revised, NAVMED P-5040 will be deleted from the listings of NAVMED P- 
publications. —Administrative Division, BuMed. * BUMEDINST. 5604. IE 



U.S. Navy Medical News Letter, Vol. 44, No. 3 19 

FROM THE NOTE BOOK 

CAPT Phillips Receives Distinguished Service Medal 

Captain Robert A. Phillips, Medical Corps, U.S. Navy, eminent U. S. Navy 
Doctor and Commanding Officer of the Naval Medical Research Unit #2 was 
awarded the Distinguished Service Medal on 2 July 1964, at his Headquarters 
in Taipei, Taiwan. 

Appropriately, the widely known Navy Research specialist had returned 
to Taipei from the Philippines less than two hours before the presentation. He 
had been conferring in Manila with medical authorities on cholera - one of 
the many diseases he has been fighting for years. 

Vice Admiral Charles L. Melson USN, Commander of the U. S. Taiwan 
Defense Command, representing President Lyndon B. Johnson, presented the 
medal to Captain Phillips, as the doctor's staff of more than three hundred 
viewed the ceremony, In reading the citation, Admiral Melson stressed its 
description of Captain Phillips' "Exceptionally meritorious service to the 
Government of the United States. " 

The citation heralded the Captain as being responsible for establishing 
and directing NAMRU-2 in its activities in the field of research and treatment 
of tropical diseases and medical disorders in the Western Pacific Area. 

It also called attention to his "skillful direction of new methods for 
field treatment of cholera which were developed and successfully applied to 
quickly bring under control serious outbreaks of this disease in East Pakistan, 
the Philippines, Korea and Vietnam. His work in directing the development 
of "a vaccine which promises ultimate control of Trachoma, " and his invalu- 
able research on parasites in man and animals in North Borneo, as well as 
his extensive study of encephalitis in Indonesia were mentioned. 

The award lauded Captain Phillips for his. brilliant leadership, pro- 
fessional skills and untiring efforts during the past eight years, in combating 
and bringing under control the diseases which once threatened members of the 
Armed Forces and plagued populations of friendly Asian countries. 

By his loyal devotion to duty, and through his practice of the People to 
People Program in each country he has visited, the Doctor has rendered val- 
uable and distinguished service and has contributed greatly to the advance- 
ment of medical science, the well being of populations of friendly Asiancoun- 
tries, and the fostering of good relations between the United States and Nations 
in the Western Pacific Area. 

This latest military honor adds another entry to the navyman's school 
of recognition. Among the Doctor's numerous citations are included the 
Republic of China's Cloud and Banner Award and the 1962 Stitt Award for out- 
standing achievement in medical research. He is also a member of the Order 
of the British Empire (Military). —From TIO, Navy Department, Washington, 

D. C. 

sfe j{t $ s{e # sjc 



20 U.S. Navy Medical News Letter, Vol. 44, No. 3 

American Board Certifications 

American Board of Internal Medicine 

LCDR William F. Spence MC USN 

(Subspecialty of Pulmonary Disease) 

American Board of Obstetrics and Gynecology 
LCDR Patrick E. Golden MC USN 
LCDR John R. Lukas MC USN 
LCDR Robert B. Small MC USN 

American Board of Orthopaedic Surgery 
LCDR Frederick George MC USN 

American Board of Pediatrics 

LT David W. Bailey MC USN 

LT Royal A. Smith MC USN 

LCDR William Martin Bason MC USN 

LCDR Luther C. Hansbarger MC USN 

JLCDR Gerald P. Largent MC USN 

American Board of Preventive Medicine 

CDR Frank H. Austin Jr. MC USN 

{in Aviation Medicine) 
CDR Benjamin F. Gundelfinger MC USN 

American Board of Surgery 

LCDR James L. Beeby MC USN 
LCDR William J. Cavin Jr. MC USN 
LCDR Mitchell Mills MC USN 
LCDR Ernest E. Weinand MC USNR 

American Board of Thoracic Surgery 

LCDR Donald M. Hopkins MC USNR 
CDR Robert J. Cales MC USN 

American Board of Urology 

LCDR John J. Donoghue MC USN 



Dual Honor Bestowed Upon CAPT Bruce Canaga . CAPT Bruce L. Canaga, Jr, 
MC USN, was elected Governor for the Navy in the American College of Chest 
Physicians at their annual meeting in San Francisco in June. At the annual 
meeting of the AMA, also in San Francisco, he was elected Chairman of the 
Section on Military Medicine. Those desiring information on either of these 
two activities are invited to correspond with Dr. Canaga who is Assistant for 
Personnel Control and Planning in the Bureau of Medicine and Surgery. 



U.S. Navy Medical News Letter, Vol. 44, No. 3 21 

New Cobalt 60 Unit at Oak Knoll 

A new Cobalt 60 Therapy Unit was dedicated at U. S. Naval Hospital, Oakland, 
on 22 June 1964 by RADM Edward C. Kenney, Surgeon General of the Navy. 
The new unit, which Admiral Kenney was instrumental in obtaining for the 
hospital, is part of the gradual modernization of the hospital's Radiology Serv- 
ice. It is the only cobalt unit in use among military installations in the area 
and will be available for treatment of personnel of all branches of the armed 
services and their dependents. 

With the opening of the new unit, Oak Knoll offers high energy radiation 
therapy for cancer patients. The gamma rays given off by radioactive cobalt 
are used in the treatment of deep-seated malignant tumors. The rays come 
from a circular piece of cobalt less than an inch in diameter, which has been 
made radioactive in an atomic pile and is now giving off powerful rays as it 
decays. The control panel operator opens a shutter to release rays "aimed" 
at the tumor. 

Gamma rays are less dangerous to normal tissues in the tumor area, 
and higher radiation levels can be obtained within the tumor than with the con- 
ventional x-ray unit. Another advantage is that fewer side effects to the patient 
result from cobalt therapy than from treatment by conventional units. 

In recent years Oak Knoll patients have received high energy radiation 
therapy through arrangements with Peralta Hospital, Oakland. 

The cobalt unit is housed in a windowless concrete room whose thin- 
nest part is 8-inch thick concrete reinforced with steel. In its thickest part 
the walls are 30 inches to insure radiation safety of the surrounding area. In a 
small outer room, the doctor and a qualified x-ray technician manipulate the 
control panel and watch the patient through closed circuit television and con- 
verse with him via a sensitive intercom system. — PIO, USNH, Oakland, Calif. 

$z ^c %t % %: ^ 

Armed Forces Tri-Service Orthopedic Seminar 

The Air Force will act as host for the subject seminar, which will be held at 
the U.S. Air Force Hospital, Keesler, Keesler AFB, Biloxi, Mississippi, on 
22-25 September 1964. 

All surgeons and residents in this specialty, on active duty are eligible 
to attend. Only a limited number of officers can be authorized to attend the 
seminar on travel and per diem orders chargeable against Bureau of Medicine 
and Surgery funds. Eligible and interested officers who cannot be provided with 
travel orders to attend at Navy expense may be issued Authorization Orders 
by their Commanding Officers following confirmation by this Bureau that space 
is available. Requests should be forwarded via chain of command, in accord- 
ance with BUMED INST. 1520. 8A. NOTE: The deadline for receipt of requests 
in this Bureau is 15 August 1964. -Training Branch, Professional Div. , BuMed. 

s}e jf: ajt jje sje * 



22 U. S. Navy Medical News Letter, Vol. 44, No. 3 




DENTAL I (.FL I SECTION 



Mis under standing of SnF£ Policy 
(Explanation) 

Background . It has come to the attention of the Bureau of Medicine and Surgery 
that some readers have misunderstood a precaution stated in "Guidance on 
Clinical Use of Stannous Fluoride as a Caries Preventive Technic, " U. S. Navy 
Medical News Letter 42(7): 22, 4 October 1963 . The misunderstood precaution 
is excerpted: 

"(4) The fluoride ion (and probably the tin ion also) will penetrate 
freshly cut dentinal tubules and cause acute pulp pathology; and therefore: 

a. Prepared cavities (with open ended dentinal tubules), should not be exposed 
during clinical stannous fluoride treatment. 

b. Stannous fluoride should not be used as an obtundant in freshly prepared 
cavities. " 

Explanation. Published reports have shown that a variety of agents will 
penetratethe tubules of freshly cut dentin. Among such agents, sodium fluoride 
applied to freshly cut dentin caused inflammation, followed by progressive 
degredation up to 80 postoperative days (J A DA 39:670-682, 1949). For this 
reason, the careful operator will refrain from applying inflammatory agents 
such as the fluoride ion to freshly cut primary dentin for the same reason that 
he refrains from applying silicate cements without an intervening cavity liner. 
Diametrically opposite this line of reasoning, in existing carious lesions, the 
application of the fluoride ion has no known effect on the pulp. This was demon- 
strated in an unpublished study conducted at the Naval Medical Res earch Institute, 
associated with the Naval Medical Research Laboratory's "Clinical Evaluation 
of Stannous Fluoride in Preventive Dentistry. " Histological examination of 
carious teeth, which had beentreated with SnF2, showed no recognizable pulpal 
condition which was not also present in the control carious teeth which had not 
been treated with SnF£. This was interpreted to mean that the cavity debris, 
carious dentin, sclerotic dentin and /or reparative dentin had prevented the 
fluoride ion from reaching the pulp. Therefore, there is no known reason to 
refrain from using SnF2 as a caries preventive agent in mouths containing 
carious teeth. 

The point of this explanation is that the original article was misunder- 
stood by some readers: 

a) SnF£ is not considered an acceptable obtundant for use in freshly prepared 
cavities for relief of postoperative pulpal sensitivity. 

b) SnF2 is considered an acceptable cariostatic agent for use in mouths con- 
taining carious teeth. 



U. S. Navy Medical News Letter, Vol. 44, No. 3 23 

c) Bureau of Medicine and Surgery policy supports the use of SnF2 as a caries 
preventive measure, as described in the original article. 

Dental Division, BUMED 

£]C *|C *|* 5p, *jC *Y« 

Intraoral Roentgenography 

Inaneffortto ensure the most efficient type of dental roentgenographic service, 
a survey of the various techniques being employed at naval dental facilities was 
conducted recently. The survey disclosed that a wide variety of techniques is 
now in use including the bisected-angle technique with either an 8 or a 16-inch 
target -film distance, the parallel film placement technique with an extended 
cone, and a fixed-time technique whereby kilovoltages are varied according to 
the density of the oral structures. 

Establishment of Policy. The survey revealed that a technique employ- 
ing both parallel film placement and a fixed exposure time with varying kilovolt- 
ages produced roentgenograms of the highest quality. Consequently, the Dental 
Division of the Bureau of Medicine and Surgery has established the policy that 
this technique will be adopted at all naval dental facilities and that instruction 
in this procedure will be given at the schools for U. S. Naval Dental Technicians. 

Bisected-Angle Technique . The bisected-angle technique depends on 
the projection of roentgen rays perpendicular to an imaginary plane that bisects 
the angle formed by the long axis of the tooth and the plane of the film. A true 
estimate of the position of this imaginary plane is essential, for if the angulation 
is incorrect, either elongation or foreshortening of the tooth image results. 
Unfortunately, the estimates vary. Other common faults in roentgenograms 
made at an 8-inch target-film distance are the shadowing of the image and 
geometric distortion caused by divergence of roentgen rays at that short distance. 
This technique therefore lacks both accuracy and consistency. 

Parallel Film Placement Technique . Consistency andaccuracy can be 
attained by positioning the film parallel to the long axis of the tooth being 
roentgenographed and projecting the rays perpendicular to the tooth — and 
consequently to the film. The two major concerns when applying the parallel 
film placement technique to intraoral roentgenography are (1) positioning and 
retaining the film parallel to the long axis of the tooth and (2) projecting the 
rays at a right angle to the film. This requires the use of a set of filmholders 
(Rinn XCP, which may be obtained commercially). These are designed to 
position the film so that it is parallel to the long axis of the tooth. At the same 
time, they indicate the alignment of the tubeheadthat will establish a perpendicu- 
lar relationship between the rays and the film, thereby eliminating the need 
for estimating angulation settings for each area and also for keeping the patient's 
head in a specific position for all roentgenograms of each jaw. 

The set consists of two instruments constructed of a cured plastic 
material one for the anterior teeth and one for the posterior teeth. Basically, 



24 U. S. Navy Medical News Letter, Vol. 44, No. 3 

each instrument is a specially constructed bite block that enables the operator 
to attain the optimum parallel relationship between the film and the teeth. 
Extending from the bite block is a rod that positively indicates the proper 
alignment for the tubehead of the x-ray unit. When the tubehead is properly 
positioned, the operator is assured that the rays are exactly perpendicular 
to the film. Another type of filmholder can be fashioned from a straight hemostat 
and a rubber bite block of the type used in general anesthesia, through which 
a hole has been drilledin the center of the long axis. The beaks of the hemostat 
are inserted through this hole as far as the hinge area. The film and a metal 
backing (or the stiff cardboard backing which accompanies each box of film) are 
then engaged by the beaks of the hemostat and are placed in the patient's mouth 
in a position that will parallel the film surface with the long axis of the tooth 
to be roentgenographed. The rubber block is adjusted as necessary, and the 
patient closes his mouth, engaging the block with his anterior teeth. The shank 
of the hemostat serves as a guide for the correct alignment of the tubehead. 
Although this may be used as an interim or emergency substitute, the Dental 
Division, BuMed policy supports purchase of the Rinn XCP instruments. 

Target-Film Distance . In intraoral roentgenography, the anatomic 
structures, particularly in the maxillae and the anterior regions of the mandiblej 
make it necessary to increase the object-film distance to obtain a parallel 
relationship. When the conventional short (8 -inch) cone is used, such an increase 
will produce an enlargement of the image. However, this enlargement can be 
prevented by using an extended cone, 16 inches or more in length. Ultraspeed 
film must be used to compensate for the increased radiation required at this 
long target-film distance. 

Kilovoltage and Exposure Time . In the older units, only the exposure 
time could be varied to provide the necessary amount of radiation; however, 
x-ray units now available enable the operator to vary the kilovoltage within a 
range of from 40 to 90 kv. p. As kilovoltage is increased, the wavelengths of 
the roentgen rays become shorter, and the ability of the beam to penetrate any 
given part completely becomes greater. With a fixed-time technique, therefore, 
it is imperative that higher kilovoltages be used in the thicker regions (such 
as the posterior maxilla) in order to ensure proper penetration and maximum 
tissue differentiation. Conversely, in the thinner regions (the mandibular 
incisors, for example) high kilovoltages are not required, and if used they 
would result in over penetration. Varying the kilovoltage for the thickness of 
the area being roentgenographed is highly recommended. Following are 
suggested kilovoltages for use in intraoral roentgenography: 

Region Maxillae Mandible 

Molar 90 kv. p. 80 kv. p. 

Bicuspid 80 kv. p. 75 kv. p. 

Cuspid 75 kv. p. 70 kv. p. 

Incisor 80 kv. p. 67 kv. p. 



U. S. Navy Medical News Letter, Vol. 44, No. 3 25 

The milliampe rage and exposure time (ma. s.) should be kept constant for each 
area and should be that which will produce optimum film density. 

Training Film . A new motion picture, entitled "Intraoral Roentgen- 
ography: Improved Equipment and Techniques, " is in production. The avail- 
ability of prints of this training film will be announced in a subsequent issue 
of the U. S. Navy Medical News Letter. This film will describe in detail the 
characteristics of roentgen rays and the use of variable kilovoltage x-ray 
equipment and will depict the individual film placements for the extended-cone 
(or long-cone) parallel technique. Dental Division, BUMED 

«.'> fcA* %1> JLp «Jt# +Jtjt 

*-|S- ^|^ Jfm rfm *f* *f* 

Personnel and Professional Notes 
News Letter Release 



Fellowship Training; announcement of 

A Postdoctoral Fellowship Program, consisting of 12 months duty under 
instruction, has been designed to augment the Dental Corps' officer education 
programs. The term "Postdoctoral Fellowship" is defined as a period of 
in-service guided learning, not contributing to accreditation. "In-service" 
means that the Postdoctoral Fellow will be fully occupied in the specialty. 
"Guided learning" means that he will work under the preceptorship of a trained 
specialist who will provide consultative and study guidance. "Not leading to 
accreditation" means that the Postdoctoral Fellowship is not intended as a 
step toward certification as Diplomate of a Specialty Board. Alternatively, 
the certificate conferred upon completion of the Postdoctoral Fellowship will 
qualify the Fellow for further assignment to duty in the specialty and may serve 
as justification for further training. (MMD 6-124 and 6-128). 

Postdoctoral Fellowships are available in the fields of periodontics, 
prosthodontics, endodontics, oral surgery and research. Dental Officers of 
the Regular Navy in the ranks of Lieutenant through Commander, and who are 
eligible for at least one year of duty within the continental United States, may 
submit their application or their request for additional informationto the Chief, 
Bureau of Medicine and Surgery. 

Fifty-Second Anniversary of the U. S. Naval Dental Corps . RADM Frank M. 
Kyes, Assistant Chief of the Bureau of Medicine and Surgery (Dentistry) and 
Chief, Dental Division, extends his WELL DONE to all dental and administrative 
officers, and dental technicians for their efforts during this fifty- second year 
of the Naval Dental Corps. Appropriate festivities are in order during the 
week of August 22 to commemorate the fifty -second anniversary of the United 
States Naval Dental Corps. Activities planning such events are requested to 
inform this bureau for historical record purposes. 



26 U. S. Navy Medical News Letter, Vol. 44, No. 3 

American Fund for Dental Education . In his annual report for 1963, Doctor 
Raymond J. Nagle, President of the American Fund for Dental Education, 
described another year of significant progress in voluntary support of dental 
education. Incorporated in 1955, the Fund was reincorporated in 1963 under 
its new name but with the same purpose. The new corporation was structured 
to facilitate both collection and distribution of funds through three divisions: 
Fund Raising, Grants and Allocations and Public Information division. 

In its short history, the Fund has given nearly a million dollars to 
dental education. In 1963, grants were made to support development of teaching 
methods, dental student loan funds, teaching fellowships and other programs. 
The Fund's total 1963 income of $318,461 was contributed by the American 
Dental Trade Association, the American Dental Association, dental -related 
business and industry, individual dentists and others. 

Naval Dental Officers may address their contributions to the American 
Fund for Dental Education, 410 N. Michigan Avenue, Chicago, Illinois 60611. 
In doing so, it is suggested that they identify themselves with the Naval Dental 
Corps. 

U. S. Navy Dental Corps Continuing Education Program . The U. S. Naval Dental 
School, Bethesda, Maryland, begins the series of short postgraduate courses 
for Fiscal Year 1965 with the course, Periodontics , to be presented 28 September 
to 2 October 1964. The instructor will be CAPT P. F. Fedi, DC, USN. 

This course consists of lectures, discussions, and clinical demonstra- 
tions. Emphasis is placed on etiology, diagnosis, early treatment, prevention, 
and changes in occlusal trauma. Practical approaches to eliminate the perio- 
dontal pocket are discussed. Surgical procedures are reviewed. Quotas for 
this course have been assigned COMONE, COMTHREE, COMFOUR, COMFIVE, 
COMSDC, COMNINE, PRNC, SRNC and CNATRA. This short course is open 
to active duty career dental officers of the Armed Forces, in accordance with 
these quotas established by the Bureau of Medicine and Surgery. 

Applications should be received in the Bureau as early as possible, and 
preferably not less than four weeks prior to the commencement of the course. 
The Bureau Professional Advisory Board will make recommendations on all 
requests, and upon approval by the Surgeon General, applicants will be notified 
as to the final action. Those approved will be nominated for TAD or authoriza- 
tion orders as appropriate. Accounting data will be forwarded to the individual 
officers nominated for TAD orders. Staff dental officers not utilizing assigned 
quotas should report this information to BuMed Code 6112 one month prior to 
the convening date of the course. This will allow the Bureau to fill the quota 
from other districts. 

Dental Folder DP 722-1 to Identify Current Duty Station . The attention of all 
dental officers is directed to BUMEDINST 6150. 26 concerning the identification 
of current duty station on the Dental Folder, DD 722-1. The intent of this 
directive is to reduce the need to forward 603 's to the Bureau in compliance 
with MANMED 6-108(3) (c). 



U. S. Navy Medical News Letter, Vol. 44, No. 3 



27 



Joint Meeting of Navy and Civilian Dentists at Argentia . CAPT N. R. Oliver 
DC USN, Dental Officer, Naval Station, Argentia, Newfoundland, hosted a 
joint meeting of his staff and 15 members of the Newfoundland Dental Society 
on 19 June 1964. In addition to films on "Hospital Dentistry with General 
Anesthesia 11 and "Endodontics," participants and their presentations were as 
follows: 



CAPT N. R. Oliver DC USN 
CAPT H. W. Pierce DC USN 
LT S. M. Hamilton DC USN 
LT C. H. Julienne DC USN 

LCDR J. S. Kitzmiller DC USN 
LT J.J. Tully DC USN 
LT P. A. Rosenbaum DC USN 
LT R. B. Carmody 




Talk on Fluoridation 

"Series of Unusual Jaw Relationships" 
Case History of "Globulo Maxillary Cyst" 
Case History of "Extraction of all Maxil- 
lary Teeth on a Three Year Old Patient" 

"Various Cases of Root Canal Therapy 
and a Dermoid Cyst" 



■>» ■>'* »<•* 
•p *p i* 



PREVENTIVE MEDICINE 



Malaria 



Among the recommendations on international protection against malaria adopted 
by the 17th World Health Assembly, the following is of special interest to Navy 
and Marine Corps activities and personnel: 

"The medical officers responsible for crews of ships and aircraft should 
be adequately trained in the diagnosis and treatment of malaria and in measures 
of personal prophylaxis. Operators and shipowners should ensure that all 
members of crews of ships andaircraft touching ports and airports in malarious 
areas are subjected to supervised suppressant treatment during a suitable 
period of time. " 

In this connection it would be worthwhile to review the BUMEDINST 
6230,11 series on control and prevention of malaria, as well as the technical 
bulletin, "Malaria, " NAVMED P-5052-10. For important procedures designed 
to control the spread of anopheline vectors of the disease, BUMEDINST 6250. 2 
series andNavy General Order No. 20 should be consulted. Medical Department 
personnel desiring more extensive information on malaria will profit by the 
sections in such standard textbooks as Hunter, Frye, and Swartzwelder, A 
Manual of Tropical Medicine , 3rd ed, , I960, Saunders, Philadelphia, and 
Rosenau's Textbook of Preventive Medicine , 8th ed. , 1956, Maxcy. Further 
information, generally more up to date than in the above publications, maybe 
obtained by addressing specific questions and requests to the Tropical Disease 
Branch, BUMED (Code 723). 



28 



U. S, Navy Medical News Letter, Vol, 44, No. 3 



200,000. 



100,000 
80,000 

60,000 



REPORTED MALARIA MORBIDITY AND MORTALITY 
IN THE UNITED STATES, 1933-1963 



TVA MALARIA CONTROL PROGRAM 



Woter management, onfilarval, and antimagtnol 

WPA MALARIA CONTROL DRAINAGE PROGRAM 

. Anfilarval measures 




1 ' »"< * r""* — i — r — r*t — » — r^ — r^T — I — r^-i — r*~t — i — p — i — i — i — i — i — r— i — « — r~ni — I — r- 1 — I — I — r— 

1933 35 37 39 41 43 45 47 49 '51 "53 55 57 59 61 63 65 '67 ^9 



YEAR 



SOURCE: NVSD and CDC 



» 



Preliminary 



U. S. Navy Medical News Letter, Vol. 44, No. 3 29 

Salmonella heidelberg Alert 

USDHEW CDC Salmonella Surveillance Rpt. No. 25, page 8, 8 June 1964. 

The incidence of Salmonella heidelberg infections in the Western States, the 
Rocky Mountains and Pacific Coast States, in recent weeks has been cause for 
some concern. 

An outbreak attributed to this serotype in Utah is currently under in- 
vestigation and evidence thus far compiled indicates the possible involvement 
of other western States. The percentage of S. heidelberg isolations from 
among the total salmonellae isolated in western States - Montana, Wyoming, 
Colorado, New Mexico and states farther west - the entire U. S. , and the U. S. 
exclusive of the western States this year has been: 

Jan. Feb. Mar. Apr. May (1st 3 weeks) 

Western States 10.6 5.4 23.9 24.9 24. 7 

Entire U. S. 7.1 4. 8 6.7 8. 1 1 0. 5 
U. S. exclusive 

of Western States 6.3 4.7 3.4 3.9 6.7 

Therefore, it is felt important to acquire follow-up information on persons in 
these states with S. heidelberg infections as soon as they are identified. If a 
food source sold in interstate commerce is responsible, it should be identified 
as soon as possible. 

Please forward any and all information to the Salmonella Surveillance 
Unit, Communicable Disease Center, USPHS, Atlanta, Georgia 30333, with 
copy to BuMed (Code 72). 



Smallpox 
Editorial from the JAMA 187(3): 224, January 18, 1964. 

In a recent report on smallpox, emphazing the possibilities of exposure and 
the importance of preventive measures, Leiterl states that". . . it is possible 
to have the procedure of vaccination accomplished even repeatedly, without 
effective vaccination. " This is true and may represent a more common cause 
of failure in the prevention of this dread disease than is generally recognized. 

In routine matters, one may unwittingly become lax. Very often people 
are satisfied to know that a medical procedure has been performed and that 
there is definite proof, written or other, of its completion. 

When a physician performs a primary vaccination, he personally checks 
the type of reaction and, before signing the certificate, makes sure that there 
was primary immune reaction, not some other form of reaction or infection. 



30 U. S. Navy Medical News Letter, Vol. 44, No. 3 

Later, for the purpose of revaccination, the patient may go to another physician 
who does not know whether immunity was accomplished initially or whether it 
still* persists. Then the revaccination should be considered as theoretically 
a primary one and evaluated as such. It is difficult to know with certainity 
if a visible scar represents a previous true immune reaction or if it is due to 
secondary infection. Further, it is not always possible to determine the ac- 
curacy of the time element, i. e. , how long ago the patient was vaccinated. A 
certificate may accidentally be misleading; it should not always be accepted at 
face value. 

In revaccination, interpretation of an immune reaction is more difficult 
than in initial vaccination. A brief skin reaction may be produced by an allergic 
or foreign-protein response rather than by immunologic processes. Careful 
evaluation of all the facts is necessary before a certificate of immunity is 
signed. Leiter's report stresses, further, the importance of using potent 
vaccine and correct vaccination procedure. 

On the physician's part, any smallpox revaccination should be considered 
as important as the first vaccination. Without meticulous evaluation, a sup- 
posed pre-existing immunity should never be accepted as fact. 

Recent developments in the field of seroprophylaxis and even in the 
field of chemotherapy of smallpox, it can still be stated definitely that smallpox 
vaccination will continue to be one of the most important preventive measures 
for years to come, with other methods supplementing it. 



1. Leiter, E. R. K. : Smallpox— Here? J. Occup Med 5:486-490, Oct 1963. 

n,? >■ *j> *|* ^O -vV *A* 

*g* *^ *^ *y* •?£* <rf+ 

Hepatotoxic Plants 

WHO Chronicle, 18(6) : 223-225, June 1964. 

The introduction of chemical pesticides in modern agriculture has raised the 
problem of the possible long-term harmful effects of the residues they leave 
on plants used for food. Yet long before the advent of these synthetic products, 
substances entering the normal composition of certain plants were probably 
responsible for a great deal of liver disease in livestock and humans, affecting 
children in particular. In tropical and subtropical countries, liver disease 
affects mainly children and young adults, while in the more developed countries, 
where the consumption of hepatotoxic plants is certainly smaller, it generally 
occurs in adults of 50 years and older. 

The role of "natural" hepatotoxins and their public health implications 
are discussed in a recent paper in the Bulletin of the World Health Organization, 
Vol 29:823, 1963. 

Fungi. Conditions in the tropics favor the growth of fungi on food which can 
then acquire toxic properties. Thus the toxicity of "yellow rice" in Japan has 



U.S. Navy Medical News Letter, Vol. 44, No. 3 31 

been traced to contamination with Fenicillium islandicum Sopp. , which produces 
at least 2 hepatotoxic compounds: luteoskyrin (a liver carcinogen), and a 
chlorine -containing peptide, the structure of which is still under study. The 
contamination with Aspergillus flavus of ground-nut meal given to turkeys and 
other fowl has caused considerable economic losses. Fed to rats in the labora- 
tory, this toxic meal has induced liver lesions very similar to those due to 
hepatotoxic pyrrolizidine alkaloids, and primary liver tumors. 

The recent recognition of these fungal hazards to health has openedup 
important new fields of study. 

Plants. The medicinal use of certain plants— unpalatable as food, but 
having certain stimulating or other desired effects— dates back to man's 
earliest beginnings. Toxic plants with immediate effects were doubtless soon 
avoided by man, who failed, however, to realize the insidious long-term ef- 
fects of others. 

The hepatotoxic action on cattle of alkaloids containing pyrrolizidine 
was discovered about 50 year s ago. Their toxicity for man was suspected only 
recently, and attention was focused on the medicinal use of certain plants con- 
taining these alkaloids. Alkaloids of this group are found in plants belonging 
to various genera, including: Senecio, Cytisus, Heliotropium, Cynoglossum , 
Trichodesma, andEchium. About 2, 000 species containing these alkaloids oc- 
cur in various parts of the world. Some 200 of them have been examined 
chemically, and the effects of a rather smaller number have been tested in 
animals. Much work remains to be done in this field. 

At the beginning of the present century the part played by Senecio plants 
in inducing liver disease in livestock— previously considered as contagious — 
was demonstrated. This stimulated work on the chemistry of the alkaloids pre- 
sent in these plants, and over the past 25 years the relationship between their 
chemical structure and hepatotoxic activity has been elucidated. Fromacom- 
parison between the harmful and harmless alkaloids in the group, it appears 
that their hepatotoxicity is conditioned by two aspects of their chemical struc- 
ture: (a) the double bond between carbons 1 and 2 of the pyrrolizidine moiety — 
for example, platyphilline and senecionine, which differ only in that the latter 
has the double bond, are respectively harmless and hepatotoxic; (b) the pri- 
mary allylic hydroxyl esterified with a branched-chain acid, not readily hy- 
drolyzable by the body's enzymes. 

The various hepatotoxic alkaloids produce similar chronic lesions in 
rats, their character depending on the susceptibility of the animal. The ef- 
fective dose of a particular alkaloid depends on its structure and varies be- 
tween 30-50 and 300-500 mg/kg body weight. The hepatotoxic alkaloids have 
produced liver injury in all the species of animals in which they have been 
tested (rats, mice, hamsters, rabbits, chickens, and monkeys), and perhaps 
in man too, as he may be susceptible to them. It is therefore of interest to 
note that plants containing these alkaloids have been recommended for medi- 
cinal purposes, and are listed in many herbals and materia medical books. 
The use of some of these plants continues to the present day in various coun- 
tries of Africa, Australasia, Asia, and Europe,. 



32 U, S. Navy Medical News Letter, Vol, 44, No. 3 

A particular plant may contain 1 or more related alkaloids, often ac- 
companied by their respective oxidation products (N-oxides), which also have 
a chronic hepatotoxic action;these products make the plants more palatable so 
that they are more likely to be consumed by livestock. The alkaloidal content 
may vary in different parts of the plant, being generally higher in roots and 
seeds than in stems and leaves. It may also vary according to the season, the 
soil, and the state of growth of the plant. Pyrrolizidine alkaloids have an- 
other peculiarity: a single dose is enough to affect the liver, but has little 
or no effect on the central nervous system. These alkaloids interact with cer- 
tain constituents of parenchymal liver cells in a way that leads to irreversible 
and progressive changes. Large doses can produce acute liver damage, centrilo- 
bar necrosis, lung edema, and the death of the animal within a few days. If wean- 
ling rats are given doses that cause 30% of them to die from acute liver damage, 
the remaining rats may survive up to 2 1/2 years, or more. The liver damage 
to these survivors varies in extent, and may consist only of a few enlarged 
cells or slight periportal infiltration. On the other hand, they may develop 
obvious liver disease, with rapid loss of weight or ascites and distended ab- 
domen. At death the livers may be nodular, with varying degrees of fibrosis. 
Hepatomas develop only occasionally after a single dose;more often they de- 
velop after repeated intermittent administration of small doses. However, the 
optimal condition for the development of liver tumors following ingestion of 
these alkaloids has not yet been determined. 

Little is known about the mechanism of action of the alkaloids. The de- 
velopment of characteristic large cells in the liver and the lung suggest that 
they interfere with cell division. Sex, age, and diet are among the factors on 
which susceptibility to the alkaloids depends. Male rats are more susceptible 
than female, young rats than adults, and those with protein deficiencies than 
those that are well fed. Female rats, while remaining unscathed themselves, 
may pass a toxic factor on in their milk, so that their young are affected. 
Hepatotoxins of Aspergillus flavus are excreted in the milk of cows fed on 
toxic ground-nut meal; when absorbed by pregnant animals, they may have 
teratogenic effects on the fetus. 

Public Health Implications . The discovery of hepatotoxic compounds in 
certain plants suggests that other toxic substances may be contained in natural 
products, and that these maybe responsible for various diseases ofmysterious 
origin that occur in unsophisticated pastoral communities, e. g. , onyalay,kuru 
in New Guinea (WHO Chronicle 18:25, 1964), Kaposi's sarcoma, Burkett's sar- 
coma in African children, and amyotrophic lateral sclerosis in Guam. 

From what is known of the action of hepatotoxic substances, it is in 
children, who are much more susceptible than adults, that the causative agents 
of liver disease should be sought. The early age at which such diseases as 
cirrhosis of the liver and primary liver tumors occur in unsophisticated com- 
munities points to factors operating either in utero or postpartem. 



1. Schoental, R. , Proc Roy Soc Med 53: 284, I960. 

****** 



U. S. Navy Medical News Letter, Vol. 44, No. 3 33 

Chimpanzee -Associated Hepatitis - 1963 

USDHEW PHS Morb and Mort Wkly Rpt 13(21): 174, 29 May 1964. 

During 1963, 13 cases of infectious hepatitis in the United States, traced 
epidemiologically to exposure to non-human primates, were reported to the 
Hepatitis Surveillance Unit, CDC. Three outbreaks were responsible for 11 
of these 13 cases. 

The first outbreak (cases 1-5) occurred at a university in Oklahoma, 
according to the Communicable Disease Control and Laboratory Services, 
Oklahoma State Department of Health. In early November, 2 chimpanzees 
were shipped from Sierra Leone via the West Coast to a psychologist; they 
were housed in animal quarters adjacent to his home. Because one of the 
animals had a severe respiratory infection, contact with humans was limited 
to those necessarily involved in the care of animals. Between 26 December 
1962 and 17 January 1963, 5 of the 7 persons who did have close contact with 
the chimpanzees developed hepatitis. One of the psychologists, who remained 
well, was believed to have had icteric hepatitis at age 12. Investigators were 
unable to trace these cases to any other possible common source. 

The second outbreak (cases 6-8) involved 3 of 26 animal handlers and 
veterinarians at a U. S. Army Base. Two importers shipped a total of 26 
chimpanzees to the base during March. In late April and early May, 2 officers 
and 1 enlisted man, all closely involved in the care of these animals, developed 
infectious hepatitis. No other common source could be found to account for 
this outbreak. 

Case 9 occurred 5 1/2 months later at the same Army base— an animal 
caretaker who began work in July — and was not exposed to any of the animals 
responsible for the earlier outbreak. A new shipment of chimpanzees had 
arrived in August; this man was the only one of 10 individuals exposed who 
developed hepatitis. Some of these same workers, however, were exposed to 
the earlier shipment and had received immune globulin injections in May. 

Case 10 was a young New Yorker who worked for the importer supplying 
chimpanzees to the above Army base. Although he regularly handled chimpanzees , 
he began work in April, well after the initial shipments had been made. Because 
of hepatitis he stopped work in early June, before the animals shipped in August 
to the Army base would have arrived at the importing house. 

The last outbreak (cases 11-13) occurred at an Air Force base where 
chimpanzees are used in psychological and space research. Case 11 had been 
hospitalized in November 1961, because of an elevated SGOT which was found 
during a survey of all veterinary personnel, prompted by the occurrence of 
several cases oi chimpanzee -associated hepatitis at that time. His second 
illness, in 1963, was severe and prolonged. Although 7 separate shipments 
of young chimpanzees were made to this institution during early 1963, the 3 
cases were compatible with exposure to a single shipment in May. 

Since the original report by Hillis* in 1961, in which 1 1 of 21 animal 



34 U. S. Navy Medical News Letter, Vol. 44, No. 3 

handlers and veterinarians developed hepatitis following exposure to recently 
imported chimpanzees, an additional 76 cases of hepatitis occurring after 
exposure to these and other non -human primates have been collected through 
the cooperation of State Health Departments and the Division of Foreign Quar- 
antine, U. S. P. H. S. 

The repetitive occurrence of these outbreaks lends credence to the idea 
that, under proper circumstances, certain species of newly-imported primates 
can transmit hepatitis to humans. No instances are known of such transmission 
involving animals which had been in the United States for longer than 6 months. 



1. Hillis, William D. : An Outbreak of Infectious Hepatitis Among Chimpanzee 



Handlers at a U. S. Air Force Base. Am. J. Hyg. 73: 316, 1961. 

* % # # # # 

Meningitis (Listeria) in 
N e wf o undland 

Chief Medical Health Officer, Epidemiology Div. , Dept of National 
Health and Welfare of Canada. Epid. Bull. 7(3): 31-32 March 1963. 

A 5 -week old male infant was admitted to the isolation wing of the St. John's 
General Hospital, Newfoundland, on 21 January 1963, with a provisional diag- 
nosis of meningitis. The infant had become ill with fever, 2 to 3 days prior 
to admission to the hospital. On examination, he had a temperature of 103° F. , 
neck rigidity, bulging fontanelle and generalized convulsions. Direct examina- 
tion of the cerebrospinal fluid detected no organisms; however, overnight 
incubation of a small specimen of the fluid at room temperature revealed many 
small and evenly stained gram positive bacilli with rounded ends. Culture 
yielded a moderate growth of Listeria monocytogenes . 

This was an only child, normally delivered at full term, with a birth 
weight of 6 lbs. 7 ozs. The small family lived in substandard housing in the 
fringe area of the city of St. John's. There were no pets or animals, and 
no rats or mice had been seen in the house. About 10 days before the infant's 
illness, 2 rabbits (snow shoe hares imported frozen from New Brunswick) 
had been purchased from a store and were skinned and plucked in the house 
prior to consumption by the parents. Listeria antibody titers were 1:40 for 
father and 1:60 for the mother. 

This is the third case of Listeria meningitis in an infant diagnosed in 
this province since 1957. Listeria monocytogenes caused an epidemic among 
dogs in Labrador and has also been isolated from snow shoe hares in this 
province. 

sjc # % # # # 



U. S. Navy Medical News Letter, Vol. 44, No. 3 35 




DID YOU KNOW: 

That through the summer of 1963, the encephalitis virus was very active 
in the Midwest of the United States ? 

More than 700 cases were reported in horses, in the states of North 
Dakota, Minnesota, Iowa, South Dakota, Nebraska, Kansas and Missouri. The 
virus isolated in nearly all of these states proved to be Western Encephalitis. 
The states will be watching encephalitis very closely during the coming season. (1) 



That 51 cases of poliomyelitis had been recorded in the Bahamas as of 
20 June 1964? 

The outbreak, which began in mid-March 1964, reached its highest 
incidence during the first half of April, Type I poliovirus was identified as 
the etiologic agent. The second feeding of the trivalent vaccine has been 
carried out, and 59,498 (71.4%) of the population in New Providence Island, 
and 45, 077 (93%) of the population in the Out Islands have been vaccinated. (2) 



That 28 imported cases of dengue fever were reported by 8 States during 
the latter part of 1963 and early 1964 in individuals who acquired the disease 
while in the Caribbean? 

Eleven of the afflicted appear to have acquired the disease in Puerto 
Rico, 10 in Jamaica, 3 in the Virgin Islands and 1 in Antigua in the Lesser 
Antilles. One patient had visited Puerto Rico and the Virgin Islands. Of the 
Jamaican cases, 9 were among members of 2 families. The majority of cases 
had dates of onset in July, August, and September when dengue was frequently 
reported in Jamaica and Puerto Rico. No imported cases have been reported 
with onsets later than March. 

Of cases with available clinical data, all experienced fever, from 101° 
to 106° F, , headache, orbital and muscular pain, 19 of 24 had a skin rash. 
Serological confirmation was available for 14 of the patients; all recovered 
without known sequelae. 

Without question, the 28 cases represent but a fraction of the actual 
number which have occurred in the United States. Many have probably not 
been recognized as dengue, even among those who sought medical attention. 
The absence of reports of imported cases over the past 4 months suggests that 
the dengue incidence has abated in the principal Caribbean tourist areas. This 
is substantiated by reports from these areas. (3) 



That confirmed jungle yellow fever was reported from Mengo District 



36 U.S. Navy Medical News Letter, Vol. 44, No. 3 

(B Uganda Province), Uganda, in a patient who died in May, 1964? 

This is the first case of human yellow fever reported in an East African 
country in more than 10 years. The last one in Uganda was from another 
Province in 1952. (4) 

That on 2 January 1962, a single specimen of Aedes vexans nocturnus 
(Theobald) was found in a light -trap catch at the Public Health Service Quaran- 
tine Station in Honolulu? 

This, an inadvertent introduction of a mosquito species into Hawaii, 
was the first to be recognized since the turn of the century and the days of the 
sailing vessel. Since then, a heavy incidence of mosquito adults and larvae 
was discovered on the Ewa side of Pearl Harbor. Immediately civilian and 
military agencies moved to determine the extent of infestation and to prevent 
the rapid spread of the species to other parts of Oahu and neighboring islands. 
Later surveys showed spread of the species throughout most of Oahu from 
Waimanalo to Kahuku, Waialua, and Waianae; it is also established on the 
island of Kauai. 

This species, a potential vector of Japanese "B" encephalitis, has been 
intercepted a number of times on aircraft through quarantine inspection. The 
source of introduction may be Guam, Samoa, Fiji, Philippines, or the Marshall 
Islands, since all have ports of departure for aircraft and ships coming to 
Hawaii. 

Mosquitoes were unknown in Hawaii until 1826. Today, Aedes aegypti , 
A. albopictus, A. vexans nocturnus , Culex quinquefasciatus , andtwo purposely 
introduced Toxorhynchites species are present. (Larvae of Toxorhynchites 
mosquitoes are predaceous on other mosquito larvae; adults are not able to 
feed on blood. — Editors). (5) 



Bibliography: 

1. USDHEW PHS Vector Control Briefs, No. 12, page 6, May 1964. 

2. WHO PAHO Wkly Epid Rpt XXXVI(27): 156, 1 July 1964. 

3. USDHEW PHS Morbidity & Mortality Wkly Rpt 13(27): 235, 10 July 1964. 

4. USDHEW PHS Morbidity & Mortality Wkly Rpt 13(27): 240, 10 July 1964. 

5. USDHEW PHS Publ Hlth Rpts 79(1): 24, Jan 1964. 

H^** ?}£ 5jC trfm +fm +(* 

In Switzerland economic losses due to tuberculosis in cattle averaged $12 
million each year from 1943 to 1959. Of this annual sum, about $2. 8 million 
represented losses due to bovine tuberculosis contracted by humans. In I960 
the disease was eradicated, and in that year the usual $12 million loss was 
replaced by an expenditure of less than $1. 3 million on eradication pro- 
cedures. -WHO Chronicle 18(7): 238, July 1964. 



U. S. Navy Medical News Letter, Vol. 44, No. 3 



37 



New Section 



A LOOK AT OUR U. S. NAVAL HOSPITALS 



YOKOSUKA 



{First in a Series)* 

The U.S. Naval Hospital, Yokosuka, Japan is located within the confines of 
the U. S« Naval Fleet Activities, in the city of Yokosuka, Japan which has a 
population of 308, 314 people and is located on the Miura Peninsula, approximately 
forty miles south of Tokyo. Construction by the Japanese Navy of what is now 
the U. S. Naval Hospital, Yokosuka was commenced on 31 March 1927 and com- 
pleted on 20 February 1931. During World War II this hospital was occupied 
as an Imperial Japanese Navy Medical Center which included a Hospital Corps 
Training School and a Naval Hospital which had a normal staff of 237 and a 
war-time staff of 735 officers and men. The bed capacity was listed then as 
578 normal, 690 maximum, and 857 emergency. The buildings in the present 
U. S. Naval Hospital compound are substantially the same as when it was orig- 
inally constructed by the Japanese Navy. 




Official U. S. Navy Photograph of U. S. Naval Hospital — Yokosuka, Japan. 



Adapted from material contained in Hospital's Briefing Brochure of May, 1964. 



38 U. S. Navy Medical News Letter, Vol. 44, No. 3 

The general arrangement and construction made it convenient for con- 
version to a Fleet Activities, Yokosuka, Dispensary for our Naval Forces, 
when we occupied Japan. It offered valuable potential as a future U. S. Naval 
Hospital. 

Shortly after the start of the Korean Conflict the U. S. Naval Hospital, 
Yokosuka was established by the Secretary of the Navy and it was commissioned 
on 11 September 1950. The month of December 1950 brought the hospital's 
greatest work load, the peak in patient census being reached on 14 December 
1950 when there were 4, 388 on the sick list. Once during this period there were 
2, 000 patients admitted within a 24 hour time span. 

In December 1951 the Secretary of the Navy awarded the Navy Unit 



Citation to the U.S. NAVAL HOSPITAL, YOKOSUKA, "For extremely meritori- 
ous services in the treatment and hospitalization of 5, 804 war casualties and 
other patients from 5 December 1950 to 15 January 1951". Captain Walter F. 
James, MC, USN (later RADM rank) was the hospital's Commanding Officer 
at the time of the record patient load. 

Some Events of 1963 

The year 1963 was a busy one at the hospital and saw many changes in 
the hospital staff; several innovations were instituted in the various services. 
A brief resume by Service follows: 

During 1963 there was a complete staff change of American Red Cross 
personnel with Miss M. E. Doehler assuming duty as Hospital Field Director 
in May. The staff as of 31 December 1963 consisted of a Hospital Field Direc- 
tor, Recreation Supervisor, Social Work Aide, Recreation Aide and a secretary 
hired locally. The career staff was assisted by a monthly average of 26 
volunteers serving as Gray Ladies and 18 volunteers serving as staff aides in 
the various clinics. 

The summer of 1963 marked the first time Youth Volunteers served at 
this Hospital on a scheduled basis. A total of seven young ladies participated 
in the Recreation Program in the Red Cross Offices. 

The Anesthesiology Service administered 1628 anesthetics of all types 
without a single mortality. It has in addition been quite active in treating acute 
and chronic respiratory problems. When and if more personnel become avail- 
able it is planned to add a complete inhalation therapy branch to this service. 
Modernization of equipment has included two new gas machines and the addition 
of an assistor-controller of the "Bird" type. 

Deliveries in the Obstetrics Branch showed a 15% increase over the 
previous high for the past five years. 

Dispensary Service handled a total of 3, 175 complete physical examina- 
tions, 1,898 limited physicals, and 29, 841 medical clearance examinations for 
a grand total of 34, 194. 

The emergency treatment room and sick call section took care of 
26, 337 patients for conditions ranging from abdominal gunshot wounds to 
hangnails. 



U. S. Navy Medical News Letter, Vol. 44, No. 3 39 

The military section gave 26,197 immunizations; the dependent section 
gave a total of 19, 561, for a grand total of 45, 758. 

During "Operation Sweet Tooth", the Tri-Service Oral Polio immuniza- 
tion project, 16, 439 pink cubes of sugar were dispensed to military, dependent 
and authorized civilian personnel. 

Statistically the EENT Service showed approximately 25% increase in 
services rendered, including the following: consultations 14, 523, major sur- 
gery 199, minor surgery 236, audiograms 2, 836 and fabricated spectacles 
8,316. 

A total of 211, 847 Laboratory procedures were performed during the 
year, 103, 555 on in-patients. This represents an increase of 60, 082 tests over 
the previous year. The Blood Bank performed 1, 555 cross matches and drew 
517 units of blood. A pulmonary function laboratory was established to assist 
in Tri-Service research into Tokyo -Yokohama Asthma. 

Approval was obtained from BUMED and BUPERS for reactivation of a 
Psychologist Billet. 

Photodosimetry was accomplished on film badges for all commands in 
the Far East area. 

An X-Ray field unit with all accessories has been encased in an airplane 
engine tank for storage in the caves for emergency use. 

The project for enlargement of the operating room was not expected to 
be completed until May 1964. Cyclomatic controls were installed on the existing 
autoclaves in the operating room thus allowing for automatic timing and recording 
of autoclaving temperatures. The recovery room was modernizedby the addition 
of four new recovery room stretchers and two new recovery room cribs. 

The Patient Affairs Division performed the following administrative 
services; Patient admissions 5, 537, patient discharges 4, 844, patient transfer 
via medical air evacuation system 726. Prepared birth certificates and citi- 
zenship registration documents on 688 live births. Handled 83 decedent affairs 
cases. 

The Food Service Division served 218, 025 rations at an average cost 
of $1. 0956 /ration. There were 823 complete steak dinners served to blood 
donors and mothers of newborns. New equipment installed: air -conditioner 
in diet kitchen office, coffee urn in main dining room, ice cube machine in 
main kitchen, dishwashing machine in scullery. 

On 1 February 1963, Data Processing Machines were installed at Naval 
Hospital, Yokosuka. This was the first overseas naval hospital to install 
electrical accounting machines (EAM). The introduction of EAM equipment 
in naval hospitals is a significant administrative achievement directed toward 
improved management which in turn leads to improved patient care. On 1 May 
this division commenced producing EAM card data on OB, Newborns and 
Anesthesia cases. During the period 1 May to 31 December a new EAM inpatient 
statistical reporting system was phased in on an increment basis and beginning 
Uanuary 1964 all manually produced reports were discontinued. On 1 December 
a daily patient report was initially produced by EAM methods. This Division 
has been designated by BUMED as the Regional Medical Data Processing 



40 



U. S. Navy Medical News Letter, Vol. 44, No. 3 



Support Center for all ships and stations in the Far East except Guam. 

The Chief of Orthopedics, CAPTAIN G. M. RICKETSON, MC USN 
served as Port Liaison Officer for Project Mercury Orbital Flight. 

A Pest Control Training course was presentedat the Hospital by mem- 
bers of Preventive Medicine Unit No. 6 from 30 July through 2 August 1963. 
The course was attended by representatives of all major commands within 
Naval Forces Japan. 

RADM J. L. HOLLAND, MC, USN, The Fleet Surgeon, Headquarters 
of the Commander in Chief, U. S. Pacific Fleet visited the hospital. 

Minister John K. EMMERSON, Deputy Chief of Mission, American 
Embassy, Tokyo was guest speaker at graduation ceremonies. Fourteen (14) 
Japanese interns at the U.S. Naval Hospital, Yokosuka completedtheir intern- 
ship on 15 March after a year of practicing, in an American operated hospital, 
what they learned during four years in Japanese medical schools. Interns were 
selected to practice in U.S. Military Hospitals by the Kanto Plain Tri-Service 
Committee headed by CAPT R.E. FAUCETT, MC, Chief of Medicine. Selections 
were made through competitive examinations held jointly by the Army, Navy, 
and Air Force hospitals at Camp Zama, Yokosuka and Tachikawa. This was 
the best class of interns since the program began in 1952. 

NOTE: A progress report on the Intern Training Program and a group photo 
will be published in a later issue of Medical News Letter. Editor 



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